HealthRX.com · Printable cost worksheet
Trulicity cost-help worksheet for 2026
Work out which help you can apply for this week: your household income against the 2026 poverty guidelines, the 2026 Medicare Part D limits, the documents assistance programs ask for, and a log of every application and call.
Your household and coverage
People in your household
Yearly household income before tax
Income as a percentage of the guidelineyour income divided by the guideline below, times 100
Coveragecommercial, Medicare Part D, Medicaid, TRICARE or VA, none
Trulicity dose and what you pay per fill now
2026 HHS poverty guideline, 48 contiguous states and DC[1]
| Household size | 100% of the guideline |
|---|---|
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
Medicare Part D limits in 2026
- No Part D plan may have a deductible above $615 in 2026 ($700 in 2027).[2]
- After any deductible you pay 25% coinsurance until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027).[2]
- Once you reach that limit, you pay nothing out of pocket for covered Part D drugs for the rest of the calendar year.[2]
- Anyone who qualifies for Medicaid automatically qualifies for Extra Help.[2]
Documents assistance programs usually ask for
- Most recent federal tax return (Form 1040)
- Two consecutive pay stubs, or a signed statement if you have no income
- Insurance and pharmacy benefit cards, front and back
- Your prescriber's name, office phone and fax
- Any denial letter from your plan or a program
Applications and calls
| Date | Program or plan | Reference number | Result | Next step and date |
|---|---|---|---|---|
Questions to ask
- Which income multiple and which year's poverty guidelines does this program use?
- Does my Medicare Part D coverage rule me out, or only reduce what I get?
- Could a formulary exception or tier exception lower my Trulicity cost?
- Does my local health center offer a sliding fee for medicines?
Sources for the facts on this sheet
- U.S. Department of Health and Human Services, via the Federal Register. Annual Update of the HHS Poverty Guidelines (Federal Register document 2026-00755). Accessed 2026-10-18. https://www.federalregister.gov/documents/2026/01/15/2026-00755/annual-update-of-the-hhs-poverty-guidelines
- Centers for Medicare & Medicaid Services, Medicare.gov. How much does Medicare drug coverage cost?. Accessed 2026-10-18. https://www.medicare.gov/health-drug-plans/part-d/basics/costs
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.